Focus Group Initial Questionnaire Survey

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* 1. Please enter your contact information

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

County

Email Address

Phone Number

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* 2. Do you have wifi?

Yes

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* 3. What type of device will you be using to participate in the virtual focus group?

Phone

Laptop

Ipad

Tablet

Desktop

Other (please specify)

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* 4. Have you ever participated in a discussion group or a focus group for research in the past?

Yes

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* 5. If yes, what was the topic?

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* 6. What is your age?

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* 7. What is the highest level of education you have completed?

High School or GED

Associate Degree or Tech/Business School

Bachelor Degree

Master Degree

Other (please specify)

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* 8. Major

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* 9. What is your current occupation

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* 10. List the name of your current or last employer.

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* 11. What is your current marital status?

Married

Divorced/seperated

Single (never married)

Living with a partner

Widowed

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* 12. What is your spouses/partner occupation?

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* 13. Are there any other adults living in your household?

Yes

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* 14. If yes, who?

Roommate

Family

Partner

Other (please specify)

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* 15. If yes, what is their occupation?

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* 16. Do you have children?

Yes

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* 17. If yes, what are their ages?

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* 18. Are you registered to vote?

Yes

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* 19. Do you have a Drivers License or State ID card valid in the state you live?

Yes

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* 20. Have you ever served on jury duty?

Yes

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* 21. If yes, when and where?

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* 22. What is your ethnic or racial background?

Asian

Black/African

White

Hispanic/Latino

Native American

Pacific Islander

Other

Other (please specify)

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* 23. What category does your annual household income fall into?

< $20,000

$20,000 - $40,000

$40,000 - $60,000

$60,000 - $80, 000

> $80,000

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* 24. Have you, anyone in your family or any of your close friends ever been employed in any of the following fields:

Media

Legal or Court System

Insurance claims or with an insurance company

Attorney or working in an attorney's office

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* 25. Have you, anyone in your family or a close friend, or your employer ever been involved in a lawsuit, suing or being sued, making a statement as a witness, or some other lawsuit situation?

Yes

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* 26. Have you ever been seriously injured?

Yes

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* 27. Do you consider yourself more of a conservative or more of a liberal?

Conservative

Liberal

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* 28. Is it more important for a child to have respect for elders or independence?

Respect for elders

Independence

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* 29. Is it more important for a child to have obedience or be self reliant?

Obedience

Self Reliant

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* 30. Is it more important for a child to have good manners or be curious?

Good Manners

Curious

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* 31. is it more important for a child to be considerate or well-behaved?

Considerate

Well behaved

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* 32. Do you consider yourself religious?

Yes

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* 33. How many times have you attended a church service in the last year?

0 - 5

5 - 10

10 - 20

more than 20

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* 34. Where did you hear about this focus group?

Newspaper - print

Newspaper - online

Facebook

Craigslist

Other Social Media

Other